July 31, 2004

KUALA LUMPUR – Faced with a critical shortage of nurses, Malaysia is considering increasing allowances in a bid to attract more people to the job.

About 4,000 of the country’s 27,000 nurses retire annually while only 2,500 new graduates a year are coming through, Deputy Health Minister Abdul Latif Ahmad told a nursing-college audience. The imbalance could cause problems if comprehensive plans are not put in place.
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Besides the option of increasing allowances, the government has allocated RM140 million (S$63.5 million) to upgrade facilities such as hostels and lecture halls at nursing schools.

Yet another measure is allowing foreign students to take up nursing courses and to serve here upon graduation, he said at the Seremban Nursing College.

‘We will also consider taking in foreign nurses. However, this will only be a last resort.’

The country could be turned into a teaching and training centre for foreign nurses but an in-depth study is needed, he added. — New Straits Tim

July 30, 2004

KUALA LUMPUR, July 30 (Bernama) — What does a Malaysian get with RM5 today? A plate of nasi lemak and teh tarik perhaps? Or simply the fee for parking in some area of Kuala Lumpur?

In Sudan, with RM5 one can provide a malnourished child with therapeutic feeding for a day which includes milk and nutrients.

This was told to the media by Malaysian Medical Relief Society (Mercy Malaysia) president Datuk Dr Jemilah Mahmood Friday.

She said her organisation had been requested by the United Nations (UN) agencies to lend medical assistance to the country’s Internal Displaced People (IDP).

“Basically we need about RM200 monthly to treat one malnourished child, and RM1.5 million to have and run a decent therapeutic feeding centre for six months,” she said during a media briefing on Mercy Malaysia’s six-month relief mission to the war-torn African country, beginning next month.

She said with that amount of money, Mercy Malaysia could treat at least 180,000 Sudanese at IDP camps in El-Geneina, west Darfur region.

At present the town was populated by 1.2 million of IDPs with 88 percent of them without shelter and 75 percent are children and women.

“According to the United Nations agencies, 10,000 people are expected to die by next month if they still cannot get access to basic medical supply,” she said adding that most roads to the region were inaccessible at this time of the year due to the damage caused by rain.

Dr Jemilah said Mercy Malaysia would send a team of four people this Monday, to assess the situation in the city.

“We will make preparations on what is needed based on their report, and where we are actually going because the camps cover a large area, and we need to be where we are needed most,” she said.

Six relief missions would be sent to the country from next month till February next year, involving about 60 Mercy Malaysia staff and volunteers, with the first team to be deployed in mid August, said Dr Jemilah.

“We appeal to Malaysian medical staff and practitioners to be our volunteers. This will be a good learning experience for them because we are going to deal with the condition of malnourishment, a condition we don’t have here,” she said.

These six teams, said Dr Jemilah, were to establish a basic therapeutic feeding centre as well as to provide primary health care.

“If we can, we will continue with the second phase which is to provide mental health care as well as strengthening the basic health care system,” she said.

People interested in making donations or who wish to be volunteers can call 03-42569999, 012-9162579 or 019-6366595. Donations are tax exempted.

Vector surveillance, case surveillance, health education and promotion are the strategies to control and destroy aedes mosquito breeding.

Dr Zainol Ariffin bin Pawanchee, Director of Health in Kuala Lumpur, Malaysia, highlighted this at a session on diseases carried by mosquitoes at the health seminar yesterday.

The vector surveillance is to identify dengue sensitive areas, using mosquito larva trapping devices to decrease mosquito population in residential areas, create special anti-dengue epidemic control team in out-break areas and mobilise members of the community for aedes control.

Meanwhile, case surveillance is to determine occurrence of cases according to grid areas and to determine place of transmission such as residential, school, work place and others. Health promotion, on the other hand, is to determine the target groups and information for dissemination.

At the same session, Dr Siti Romlah binti Haji Mohammad Jais, Veterinarian Officer at the Agriculture Department, stressed on the danger of pets and livestock to human health.

She said the factors in preventing all such hazards are cleanliness for the animals and visits to the veterinarian at least once a month for health checkups.

At the session, it was also revealed that houses nowadays cannot guarantee 100 per cent safety to occupants.

Many types of accidents can happen at any time. For example, fire hazards caused by carelessness that can result in loss of properties and a place to stay, injuries and even death.

This was disclosed by Awang Osman Jailani, the Public Relations Officer of the fire services department, in his working paper entitled “Hazards in domestic setting”.

He said every house should have a systematic plan to prevent fire and save lives during a fire.

Meanwhile, Dr. Pengiran Haji Khalifah, Acting Senior Medical Officer of the Health Work Practice Section, Ministry of Health, in his talk on “Workplace, health and safety”, revealed that according to the 2003 Annual Report from the Occupational Health Division, 139 cases of accidents at work were reported during the period from June to December of last year.

He said the workplace should implement hazard controls. — Courtesy of Borneo Bulletin

KUCHING, July 29 (Bernama) — Housewives are at an increasing risk of getting HIV infection as heterosexual transmission is now the main cause of AIDS cases reported in Sarawak.

Sarawak General Hospital (SGH) Sexually Transmitted Diseases and AIDS Unit head, Dr Oui Siew Kim said Thursday it was the main mode of HIV infection unlike elsewhere in the country where drug abusers and sex workers were at a higher risk.

“When AIDS cases were first detected in Sarawak in 1989, it was initially reported among foreigners, mostly Thai fishermen but now more and more Sarawakians are contracting HIV infection,” she told reporters after the opening of an HIV/AIDS Awareness Campaign For Women by Sarawak Women’s Bureau director Norjanah Razali here.

Dr Oui, who is also the State Health Services Assistant Director, said a total of 424 HIV cases had been reported in Sarawak, including 174 AIDS cases and 89 AIDS-related deaths since then.

Up to June this year, she said 34 new HIV cases, 19 AIDS cases and nine deaths were reported in the state compared to 75 HIV cases, 49 AIDS cases and 13 deaths last year and 55 HIV cases, 26 AIDS cases and 14 deaths in 2003.

She advised those with multiple partners or were in doubt of their health status to undergo counselling and medical screening at any of the government health clinics, which were free of charge.

Earlier SGH Obstetrician and gynaecologist Dr Wendy Loh said women constituted 5.5 percent of the estimated 58,000 HIV positive people in the country.

Dr Loh, who is Sarawak Family Planning Association (SFPA) Honorary Treasurer, said the number of women, who were newly infected went up by over 10-fold to 673 cases from 66 new cases in 1993.

On the campaign being funded by the Ministry of Women, Family and Community Development, she said it was to create awareness and understanding among women on HIV/AIDS.

She said it was also aimed at promoting healthy lifestyle that could reduce HIV transmissions and enable women to make responsible choices with regards to the promotion of their general wellbeing.

July 27, 2004

Having private wings in public hospitals to stop brain drain may leave the poor with inadequate healthcare, reports LOH FOON FONG.

PUBLIC hospitals all over the world have to deal with the problem of brain drain. In Malaysia, it has become more acute in recent years and to discourage doctors from leaving the civil service, private wings in Government hospitals have been opened to improve the incomes of doctors.

However, public interest groups say setting up private wings will overstretch the already limited resources in government hospitals and possibly jeopardise the health of poorer patients.

S.M. Mohamed Idris, president of the Consumers Association of Penang (CAP) says concerns regarding the set-up have been raised to the Health Ministry but they have not been addressed. For instance, there are at least 3,000 vacancies for government doctor positions. As a result of this shortage, medical officers are overworked.

There is concern that patients’ healthcare may be compromised for monetary benefits with the advent of private practice in government hospitals.
“If there is an overall manpower shortage, how is the hospital going to deploy staff to the private wing and still cope with the ever increasing number of patients?” he asks.

“There is also a shortage of first-class wards in the general hospitals, so how do we accommodate the influx of private patients into the general hospitals? There is concern that the beds may be converted for the use of private wings,” he says.

In University Malaya Medical Centre (UMMC) which has public and private wings and the corporatised Institut Jantung Negara (IJN), the cost of medicines, procedures and laboratory charges has gone up. The waiting time for heart patients who are unable to afford surgery in private hospitals can be two years or more, he says.

CAP has called on the Health Ministry to scrap the system. “Introducing private practice in government hospitals has the potential to drastically change the face of the present healthcare system. The healthcare of patients should not be compromised for monetary benefits,” says Mohamed Idris.

Citizens’ Health Initiative coordinator Dr Chan Chee Khoon fears that the needs of the poor will be neglected even more under the system.

He cites the case of a janitor at Universiti Sains Malaysia who underwent colorectal cancer surgery at Penang Hospital in 2002. She earned RM500 monthly and received no hospitalisation benefits from her private sector employer. When she was discharged from her third-class ward, she was billed RM1,662 for a stapler device for re-joining her colon after surgery and RM141 in ward charges.

“Some months later, I brought this up with the hospital director, who in turn replied that this was in line with a government directive to increase cost recovery to about 20% of the operational costs of the Health Ministry’s hospitals,” he says.

As part of the Malaysian government’s corporatisation policy, government hospitals were directed to increase the rate of their cost recovery, he says. That is because patients at government hospitals contributed about 5%-10% of the hospitals’ actual operational costs. The government’s medical services were being subsidised up to 95%.

“It is clear that our under-financed public healthcare will become even less effective for the poor when more private wings are set up in government hospitals as human and material resources are re-allocated in line with the market needs rather than the desire to serve the needs of the poor,” he says.

It is predictable that private wings will soon be encouraged to service the regional health tourism market as well, he says.

“The Citizens’ Health Initiative has repeatedly voiced its concern over such developments. We are not against foreigners benefiting from our healthcare capabilities. Indeed we can take pride in this, but we are concerned when more and more of our local health resources are diverted to serving regional and national healthcare priorities as dictated by market demand, rather than on need basis,” he says.

“The proposal to introduce private wings in government hospitals is an unworthy idea which is rife with conflict of interests. It should be definitively scrapped,” he says.

A doctor who does not want to be named says setting up private wings does not guarantee that specialists will not leave the public sector.

“There are specialists who earn a lot of money from the private wing of UMMC but some of them still leave for private practice. One reason is that they have to work long hours. The specialists can only serve in the private wing after 5pm. So they serve in the public hospital during the day and continue to work at night to earn the extra income and find that they have no life,” says the doctor.

Moreover, he says, research work that is commonly carried out in teaching hospitals may be neglected when doctors do not have time or earning incentive to carry out the task, he says.

“In Singapore, this system seems to work better. The Singapore government is more successful at keeping doctors possibly because there are more direct rewards for them. The doctors are paid well.

“The best way to retain doctors in the public sector is to give them a better salary,” he says.

Although the Malaysian government subsidises more than 90% of public healthcare costs, Chan notes that it only spent 2.04% of the Gross Domestic Product (GDP) on public healthcare in 2001. The World Health Organisation recommends that national health expenditures be 4%-8% of GDP.

He urges the Health Ministry to implement the Prime Minister’s call for transparent, accountable healthcare governance, where there is open, competitive tendering to ensure cost-efficient use of public finances for healthcare, and that resources are directed to those areas which can deliver better gains in primary health care.

He adds that the fees schedule in the private sector should also be regulated to reduce the disparity in earnings between the public and private-sector doctors.

Mohamed Idris says charges for specialist and in-patient treatment at government hospitals can be raised slightly to bring in more revenue. “Those who cannot afford to pay full rates should be given discounts or in the worst case, free treatment. Patients in the second and first-class wards should pay a greater percentage of the costs of treatment.”

Raising the current charge of RM1 for outpatients at government facilities to RM5 can bring in another RM100mil which can go towards financing healthcare, he says.

At the same time, the Social Security Organisation’s (Socso) services can be extended to include medical care in general, rather than just restricting it to industrial accidents and occupational diseases. The annual profits of Socso can be transferred to the Health Ministry through hospital payments, thus easing the financial strain of the ministry, he says.

If the contributions are still insufficient, employers and employees can each contribute RM1 a month and that will yield at least an extra RM200mil a year in Socso contributions which can be used to finance medical treatment, he says.

The United Kingdom experience has shown that the private wing system is detrimental to the rights of poorer patients. In 2002, The Observer discovered that of the more than 10,000 private patients treated in Britain’s National Health Services’ hospitals, around half came from overseas and were treated in preference to local patients, who were left on waiting lists. The private patients were treated by the same NHS doctors and nurses and often slept on the same beds and used the same equipment.

The safety of patients and staff is more important than security mechanisms, said doctors who are not in favour of opening their clinics round the clock.

Dr Koh Geok Leong said that CCTVs could not help in stopping robberies. “What’s the use of fixing CCTV when robbers can ask you to climb up to remove the recorder and your life is probably at stake?” he asked.

Dr Koh, whose 24-hour-clinic in USJ, Subang Jaya, was robbed on two occasions two to three years ago, stopped operating after midnight since January this year.

“The nurses are scared to work at such hours and the risk of falling prey to criminals is much higher after midnight,” he said.

“We tried installing a peephole through which staff could ‘check out’ patients before letting them in but it did not work.”

Echoing his views was a doctor in Bangsar who shortened his operating hours after an attempted robbery.

“Our clinic used to run 24 hours but two months ago we cut down on the operating hours because the security guard quit and our staff felt it was not safe. CCTV will not help because even banks get robbed,” said the doctor, who did not want to be named.

The clinic, which opened some 18 years ago, is currently operating from 7am to llpm to minimise the risk of getting robbed.

“We learnt from the experience of other clinics and try to prevent it from happening here,” he said.

However, a clinic manager at Jalan Pudu said that her clinic continues to operate 24 hours daily, as they did not want to disappoint those who came for treatment. “We have not faced any problems so far,” she said.

Criminals, who are only slightly deterred by safety measures taken by clinics, also target those operating normal hours, said Malaysian Medical Association (MMA) president Datuk Dr N. Arumugam.

“It is widespread at clinics located in Damansara, Petaling Jaya or Klang. Sometimes, the incidents happen at clinics which close at 10pm or midnight.”

Bernama had reported Dr Arumugam as saying on Saturday that 30% of 2,000 licensed 24-hour clinics in the Klang Valley were closing at midnight for fear of being robbed.

When asked to comment on a media report last week that the Internal Security Ministry was prepared to study the possibility of setting a special force to curb robberies at 24-hour clinics, Dr Arumugam said that while MMA welcomed the move, details would have to be worked out. He also said that installing CCTVs or employing private security firms was too expensive.

“If someone takes out a knife and points it at a doctor or nurse, how would they react? We welcome the idea but we need to know what help they can give to combat criminals,” he said.

He added that more 24-hour clinics were closing by midnight because it was getting increasingly difficult to get staff who were willing to work late hours.

“Females make up about 90% of clinic staff and it is getting more difficult to get staff to work,” he said.

Kuala Lumpur: Policies on the treatment of mental patients and those who suffer from mental health problems are being revamped.

Health Minister Datuk Dr Chua Soi Lek said there were certain components that were neglected in the existing policies such as education, curative, rehabilitation and after-care.

“There has been a neglect of mental health and as we progress I can foresee more and more people with mental health problems,” he said.

A committee headed by Director-General of Health Tan Sri Dr Mohammad Taha Arif will prepare a working paper on mental health problem.

The Ministry’s finding showed that mental illness cases have doubled in six years – from 11,120 outpatients last year compared with 5,687 in 1998.

Also, it was found that 10 to 15 per cent of these patients are suicidal or could harm other people and that 20 per cent of the population have mental health problems, but many are reluctant to seek treatment.

It was also revealed that one in four families has at least one member suffering from a mental or behavioural disorder.

Working Malaysians, increasingly prone to job-related stress, risk developing personal problems, anxiety, psychosis, schizophrenia and multiple personality disorders. In fact, 10 per cent of mental health problems are related to work and social life.

Dr Chua said people who did not know how to channel their emotions, pent-up frustrations, anxiety and depression often end up turning to drugs and psychotropic pills.

He added that gambling was also a part of manifestation of anxiety.

“People who suffer mental health also turn to Ecstasy pills, drug addiction, rape, incest and even commit crimes,” he added.

Dr Chua said depression leading to suicide topped the list worldwide with more people being killed than all the wars combined in any one year.

“It is estimated that 65 per cent of non-communicable disease in the world can be prevented, including mental health.”

To meet the increasing number of mental health cases, the Ministry would build two new mental hospitals, one costing RM300 million to replace the Permai Hospital in Tampoi, Johor, and another costing RM400 million to be constructed in Aman Jaya, Kedah.

Besides Tampoi, the other mental hospitals are the Bahagia Hospital in Tanjung Rambutan, Perak, and one each in Sabah and Sarawak. There are 108 family medicine specialists (FMS) under the Ministry trained to diagnose, treat and manage patients with mental disorder.

Until April, 52 FMS were trained in the diagnosis and treatment of depression.

Dr Chua said the Ministry would be working closely with the media, Education Ministry, NGOs, publications and politicians to make health promotion one of their activities.

“When we conducted a survey, it came as a surprise to us that 76 per cent of Malaysians were concerned about their health but did not know how to maintain their health.

“They did not know much about healthy eating and living, stress management and, most of all, where to get health-related information,” he added.

He said the survey also revealed that many did not read and that was why the Ministry has decided to give emphasis to promotion of health and on preventive aspects of health under the Ninth Malaysia Plan.

PEKAN: Tasik Chini, the country’s second-largest freshwater lake, is contaminated with high levels of e-coli, the bacteria that may have caused rashes and diarrhoea among the orang asli living near it.

This has prompted the state government to warn the 400 villagers, including 100 children aged six and under, not to drink water from the lake and wells.

Universiti Kebangsaan Malaysia (UKM) researchers in their recent expedition to the lake found high levels of e-coli, salmonella and other bacteria, collectively known as coliform, in the 202ha lake and ground water.

There are five settlements – Kampung Gumum, Tanjung Puput, Chendahan, Melai and Ulu Gumum – on the shores of the lake, which is famous for legends of lost kingdoms and dragons.

The projects included two hospitals in Keningau and Lahad Datu besides rural clinics and other facilities, he said.

He said 26 other facilities scheduled for implementation were under construction, including hospitals in Pitas, Kuala Penyu and Kunak while 87 other projects were still at the planning stage.

“Overall, Sabah received RM1.2 billion from a total of RM9.5 billion under the 8MP allocations to the Ministry, which is the biggest compared to other states,” said Dr Chua.

On Queen Elizabeth Hospital’s re-development projects, Dr Chua said it had begun since 1992 over a period of 18 years.

As of now, RM51 million had been spent for various facilities including a post-graduate centre, a car park complex, renovations to the surgical hall, the intensive care unit, as well as upgrading infrastructure such as the sewerage system.

A RM74 million specialist clinic on a four-storey block would also be part of the re-development project.

“Piling works for the block had been completed but construction has not started yet. There has been a delay…it is not true that the project has been halted due to lack of funds. The construction will start either end of the year or early next year,” he said.

THE Health Ministry on Saturday denied that the proposed specialist complex at the Queen Elizabeth Hospital had been abandoned because the Federal Government has run out of funds.

Health Minister Datuk Dr Chua Soi Lek said the development that will cost RM74 million was a little delayed as some changes had been made to the scope of work. The changes are to ensure optimal utilisation, especially in terms of flow of patients, he said.

“We want to make it more efficientÖthere are also changes in the IT component,” he said.

In this respect, he hoped the project, the foundation phase of which has already been completed, would take off by the end of this year or the latest by early next year.

According to Dr Chua, the Health Ministry was also trying to get allocation for the development of the 9-storey two tower blocks and a 5-storey podium.

When completed, the complex, located just adjacent to the QEH’s Post-Graduate Medical Centre (PGMC), would house all the government specialists under one roof.

Meanwhile, Dr Chua said Sabah was the largest recipient of healthcare allocations under the Eighth Malaysia Plan (8MP), getting about RM1.2 billion from the RM9.5 billion allocated to the Ministry.

He said the funds were for 164 projects in Sabah of which 31 per cent had been completed, while 26 projects were ongoing and another 87 planned, including the building of health clinics.

As for the QEH, he said from 1999 up to now, about RM51 million had been spent, namely for the PGMC, renovation of operation wards, ICU and ICCU (among others).

Asked on the development of Sabah Medical Centre (SMC), which was taken over by the Federal Government to be turned into a Women and Children Hospital, he said: “It would be operating once the renovation is completedÖhopefully by another year’s time.”